Device and Method for Detection and Treatment of Ventilator Associated Pneumonia in a Mammalian Subject

Abstract

Devices and methods are disclosed herein for preventing or treating ventilator associated pneumonia in a mammalian subject. The device includes an endotracheal tube having an interior surface and an exterior surface; an actively-controllable anchoring cuff comprising two or more inflatable balloons configured to contact the exterior surface of the endotracheal tube and configured to contact the trachea of a mammalian subject; a pressure sensor configured to detect pressure of one or more of the inflatable balloons; and a controller in communication with the pressure sensor, the controller configured to actively vary pressure of the two or more of the inflatable balloons of the anchoring cuff.

What is claimed is: 
     
         1 . A device comprising:
 an endotracheal tube having an interior surface and an exterior surface;   an actively-controllable anchoring cuff including two or more inflatable balloons configured to contact the exterior surface of the endotracheal tube and configured to contact a trachea of a mammalian subject;   a pressure sensor configured to detect pressure of the two or more inflatable balloons; and   a controller in communication with the pressure sensor, the controller configured to actively vary pressure within one or more of the two or more inflatable balloons of the anchoring cuff.   
     
     
         2 . The device of  claim 1 , wherein the anchoring cuff comprising the two or more inflatable balloons includes two or more actively- and independently-controllable inflatable balloons configured for independently varying pressure within the two or more inflatable balloons. 
     
     
         3 . The device of  claim 1 , wherein at least one of the two or more inflatable balloons comprises an inflatable cuff, circumferentially surrounding a longitudinal portion of the endotracheal tube. 
     
     
         4 . The device of  claim 1 , wherein at least two of the two or more inflatable balloons of the anchoring cuff are positioned at different longitudinal locations along the endotracheal tube. 
     
     
         5 . The device of  claim 1 , wherein the two or more inflatable balloons of the anchoring cuff are positioned circumferentially surrounding the endotracheal tube. 
     
     
         6 . The device of  claim 1 , wherein the controller is configured to independently vary pressures within the two or more inflatable balloons based on a pre-determined schedule. 
     
     
         7 . The device of  claim 1 , wherein the controller is configured to independently vary pressures within the two or more inflatable balloons based on sensor input that detects tissue inflammation. 
     
     
         8 . The device of  claim 1 , wherein the controller is configured to independently vary pressures within the two or more inflatable balloons based on a scheduled time at a pre-determined pressure. 
     
     
         9 . The device of  claim 1 , wherein the controller is configured to independently vary pressures within the two or more inflatable balloons based on sensor input that detects peristalsis in the esophagus of the subject. 
     
     
         10 . The device of  claim 2 , wherein the anchoring cuff including the two or more actively- and independently-controllable inflatable balloons is configured to maintain rolling contact with the esophagus and a constant position in the esophagus of the subject. 
     
     
         11 . The device of  claim 10 , wherein the anchoring cuff including the two or more actively- and independently-controllable inflatable balloons is configured to maintain a rolling toroid. 
     
     
         12 . The device of  claim 10 , wherein the anchoring cuff including the two or more actively- and independently-controllable inflatable balloons is configured to maintain three or more azimuthally separated rolling spheres. 
     
     
         13 . The device of  claim 1 , wherein a first set of the inflatable balloons is configured to form a first anchoring cuff, a second set of the inflatable balloons is configured to form a second anchoring cuff; and wherein the controller is configured to provide instructions to independently control a pressure of the first set of inflatable balloons relative to a pressure of the second set of inflatable balloons. 
     
     
         14 . The device of  claim 13 , wherein the controller is configured to provide instructions to apply a first pressure to each balloon of the first set, and to apply a second pressure to each balloon of the second set. 
     
     
         15 . The device of  claim 13 , wherein the controller is configured to set the pressure applied to the first set of balloons to a value below a specified anchor pressure, while setting the pressure applied to the second set of balloons at a value at or above a specified anchor pressure. 
     
     
         16 . The device of  claim 1 , comprising a sensor configured to detect inflammation of tissue proximate the endotracheal tube. 
     
     
         17 . A method comprising:
 detecting with a contact sensor insertion of an endotracheal tube into a trachea of a mammalian subject, the endotracheal tube including an actively-controllable anchoring cuff including two or more inflatable balloons in contact with an exterior surface of the endotracheal tube;   detecting pressure of one or more of the inflatable balloons with a pressure sensor; and   actively varying pressure of the one or more of the inflatable balloons of the anchoring cuff under instructions from a controller in communication with the pressure sensor.   
     
     
         18 . The method of  claim 17 , comprising applying pressure under instructions from the controller at or above a specified anchor pressure to a first set of one or more of the inflatable balloons. 
     
     
         19 . The method of  claim 18 , wherein the anchoring cuff inhibits motion of the endotracheal tube within the trachea. 
     
     
         20 . The method of  claim 19 , comprising applying pressure under instructions from the controller below the specified anchor pressure to a second set of the one or more of the inflatable balloons. 
     
     
         21 . The method of  claim 20 , comprising increasing pressure under instructions from the controller of one or more inflatable balloons of the second set to a value at or above the specified anchor pressure, decreasing pressure under instructions from the controller of one or more inflatable balloons of the first set to a value below the specified anchor pressure, wherein the anchoring cuff is configured to inhibit motion of the endotracheal tube within the trachea. 
     
     
         22 . The method of  claim 17 , comprising decreasing pressure under instructions from the controller of one or more of the inflatable balloons to a value below the specified anchor pressure, and wherein the anchoring cuff is configured to extract the endotracheal tube from the trachea. 
     
     
         23 . The method of  claim 17 , comprising differentially varying pressures under instructions from the controller of two or more of the two or more inflatable balloons. 
     
     
         24 . The method of  claim 17 , wherein at least one of the two or more inflatable balloons comprises an inflatable cuff circumferentially surrounding a longitudinal portion of the endotracheal tube. 
     
     
         25 . The method of  claim 17 , comprising positioning at least two or more of the two or more inflatable balloons of the anchoring cuff at different longitudinal locations along the endotracheal tube. 
     
     
         26 . The method of  claim 17 , comprising positioning the two or more inflatable balloons of the anchoring cuff circumferentially surrounding the endotracheal tube. 
     
     
         27 . The method of  claim 17 , comprising independently varying pressures under instructions from the controller based on a pre-determined schedule. 
     
     
         28 . The method of  claim 17 , comprising independently varying pressures under instructions from the controller based on sensor input that detects tissue inflammation. 
     
     
         29 . The method of  claim 17 , comprising independently varying pressures under instructions from the controller based on a scheduled time at a pre-determined pressure. 
     
     
         30 . The method of  claim 17 , comprising independently varying pressures under instructions from the controller based on sensor input that detects peristalsis in the esophagus of the subject. 
     
     
         31 . The method of  claim 17 , comprising maintaining under instructions from the controller rolling contact of the anchoring cuff with the esophagus and a constant position in the esophagus of the subject. 
     
     
         32 . The method of  claim 31 , comprising maintaining under instructions from the controller rolling contact of the anchoring cuff including the two or more actively- and independently-controllable inflatable balloons configured to maintain a rolling toroid. 
     
     
         33 . The method of  claim 31 , comprising maintaining under instructions from the controller rolling contact of the anchoring cuff including the two or more actively- and independently-controllable inflatable balloons configured to maintain three or more azimuthally separated rolling spheres. 
     
     
         34 . The method of  claim 17 , comprising detecting tissue inflammation proximate the endotracheal tube in the subject with a sensor. 
     
     
         35 . A device comprising:
 an endotracheal tube having an interior surface and an exterior surface;   an actively-controllable anchoring cuff including two or more actively- and independently-controllable inflatable balloons configured to be inflated to differentially varying pressures, wherein the two or more inflatable balloons are configured to contact the exterior surface of the endotracheal tube and configured to contact the trachea of a mammalian subject; and   a controller in communication with the pressure sensor, the controller configured to actively vary pressure within one or more of the two or more inflatable balloons of the anchoring cuff.   
     
     
         36 . The device of  claim 35 , comprising a pressure sensor configured to detect pressure within one or more of the two or more inflatable balloons. 
     
     
         37 . A method comprising:
 detecting with a contact sensor insertion of an endotracheal tube having an interior surface and an exterior surface into a trachea of a mammalian subject, the endotracheal tube including an actively-controllable anchoring cuff comprising two or more inflatable balloons in contact with the exterior surface of the endotracheal tube; and   actively and independently varying pressure of the two or more of the inflatable balloons of the anchoring cuff under instructions from a controller in communication with a pressure sensor.   
     
     
         38 . The method of  claim 37 , comprising detecting pressure of one or more of the two or more inflatable balloons with a pressure sensor. 
     
     
         39 . The method of  claim 37 , comprising applying pressure under instructions from the controller at or above a specified anchor pressure to a first set of two or more of the inflatable balloons. 
     
     
         40 . The method of  claim 39 , wherein the anchoring cuff inhibits motion of the endotracheal tube within the trachea. 
     
     
         41 . The method of  claim 40 , comprising applying pressure under instructions from the controller below the specified anchor pressure to a second set of the one or more of the inflatable balloons. 
     
     
         42 . The method of  claim 37 , comprising differentially varying pressure of the two or more of the inflatable balloons of the anchoring cuff under instructions from a controller in communication with the pressure sensor. 
     
     
         43 . The method of  claim 37  comprising:
 inserting a device including the endotracheal tube into the trachea of the mammalian subject.